bims-cliped 2026-07-26 papers

bims-cliped

Biomed News

on Clinical pediatrics

Issue of 2026–07–26
25 papers selected by
Alyssa M. Portwood, Akron’s Children

Blood Culture Practices in Pediatric Intensive Care Units to Inform a Diagnostic Stewardship Intervention.
Pediatric firework-related upper extremity injuries: A 10-year review of cases presented to United States emergency departments, 2015-2024.
Climate Stewardship in the Clinical Setting.
Characteristics of US Nonchildren's Hospitals That Lost Pediatric Inpatient Capability, 2013-2021.
Trends in Pediatric Hospitalizations Following Interfacility Transfer: 2009-2022.
Early Prediction of Critical Care Interventions From Pediatric Emergency Department Triage.
Respiratory-Related Hospital Admissions in Children and Young Adults With Down Syndrome.
Childhood exposure to pornography and the normalization of online exploitation.
Basketball-Related Injuries Increased in Pediatric Patients Presenting to United States Emergency Departments Between 2019 and 2023 With Strains and Sprains Being the Most Common Injury Types.
Influenza, COVID-19, and RSV Vaccinations for Immunocompromised Children and Household Contacts.
Rapid MRI for Pediatric Acute Abdominopelvic Pain in the Emergency Department: Review of Imaging Technique, Implementation, and Diagnoses.
Building the Foundations for Trustworthy AI in Pediatrics.
Integrating Psychological Care into Pediatric Sports Medicine: Levels of Collaboration and Common Referral Concerns.
Social Identities and Vaccine Exemptions in the United States: The Role of Religiosity, Partisanship, and Vaccine Hesitancy.
Legacy at the Bedside: A Nurse-Led Evidence-Based Framework for Memory-Making in the Pediatric Intensive Care Unit.
An Update to the Classification, Evaluation, and Management of Childhood Interstitial Lung Disease in Infancy: An Official American Thoracic Society Clinical Practice Guideline.
Access to Autism Behavioral Therapy Services: An Analysis of 2022-2023 National Survey of Children's Health Data.
Bereavement Interventions for Children and Adolescents: An Evidence and Gap Map of Primary Studies and Systematic Reviews.
Larger versus smaller red blood cell volume per transfusion in hospitalized adults, children and preterm neonates.
The use of mindfulness based interventions for school-aged children with ADHD in the United States - a literature review.
Lower Extremity Sprains and Knee/Ankle Injury Predominate Among Pediatric Dancers.
Leading Mechanisms of Unintentional Injury Death Among Youth Ages 10-19 Years: United States, 2024.
A Qualitative Analysis of Parent-AYA Communication About Cancer Predisposition Diagnosed During Pediatric Cancer Care.
Subcutaneous Drug Administration in Pediatric Palliative Home Care: A Multicenter Prospective Study.
Implementing Screening, Brief Intervention, and Referral to Treatment in the Emergency Department: A Qualitative Evaluation of Impact and Challenges.

Hosp Pediatr. 2026 Jul 20. pii: e2025009113. [Epub ahead of print]

Blood Culture Practices in Pediatric Intensive Care Units to Inform a Diagnostic Stewardship Intervention.

and the BrighT STAR LIBRA authorship group

BACKGROUND: Blood culture practice patterns, including blood culture indications and thresholds to culture based on patient-level factors, vary among pediatric intensive care units (PICUs) and pediatricians, and over-testing can be common.
METHODS: Nine PICUs across the United States performed audits of randomly selected blood cultures in PICU patients across 4 seasons in a 12-month period. Cultures were audited for indication and associated clinical and patient-level factors. Sites applied their institutional guidelines to define fever and immunocompromised states. Data were analyzed to determine if certain culture indications were associated with sites' baseline blood culture rates.
RESULTS: In total, 1068 cultures were audited with a 6% positivity rate. New symptoms (such as fever, hypothermia, or concern for sepsis) accounted for most cultures obtained (71%), with concern for sepsis documented in about 38% of culture episodes. More than half of cultures were obtained despite a documented alternative source of symptoms. The practice of collecting asymptomatic or surveillance cultures was highly variable across sites, with 3 sites accounting for 84% of all asymptomatic cultures.
CONCLUSIONS: A large proportion of blood cultures in PICU patients were drawn for new symptoms, though often without a clear concern for sepsis and when an alternative source of symptoms was suspected or documented. Practices were variable regarding surveillance cultures. Work to develop and optimize thresholds and standard practices for sending cultures is critical to inform ongoing diagnostic stewardship efforts.

DOI: https://doi.org/10.1542/hpeds.2025-009113
Injury. 2026 Jul 16. pii: S0020-1383(26)00485-7. [Epub ahead of print]57(10): 113498

Pediatric firework-related upper extremity injuries: A 10-year review of cases presented to United States emergency departments, 2015-2024.

Coen R Zediker, Kallie E Crowl, Jacob S Krul, Michael Megafu, Xinning Li, Robert L Parisien, Antonio Cusano.

   CONTEXT: Fireworks remain a prominent feature of U.S. holiday festivities but continue to pose significant risks, particularly to children and teenagers. Although earlier studies have examined patterns of pediatric injuries linked to fireworks before 2015, recent nationwide data are sparse. This investigation seeks to fill that void by evaluating nonfatal upper extremity injuries related to fireworks among pediatric patients seen in American emergency departments from 2015 through 2024. The goal is to provide a current, detailed summary of injury rates, demographic trends, anatomical injury patterns, and age-related vulnerability.
STUDY DESIGN: This descriptive retrospective epidemiological study utilized data from the National Electronic Injury Surveillance System (NEISS), a database that generates nationally representative estimates of emergency department-treated injuries in the U.S. All pediatric firework-related injuries to the upper extremity reported between January 1, 2015, and December 31, 2024, were included in the analysis.
RESULTS: Between 2015 and 2024, 434 pediatric firework-related upper extremity injuries were identified (NE = 16,872). The majority occurred in males (77.9%) and adolescents aged 12-17 years (48.4%). Injuries most commonly involved the hand (48.8%) and fingers (32.7%). Thermal burns were the predominant diagnosis (74.0%), followed by amputations (9.0%) and lacerations (6.0%). Most patients (78.8%) were treated and released from the emergency department, while 13.8% required hospitalization.
CONCLUSION: Pediatric upper extremity injuries from fireworks remain a significant and preventable source of morbidity, with thermal burns and trauma to the hands and fingers being most common. Adolescent males are disproportionately affected, and injuries peak during holiday periods. These findings support the need for strengthened regulations and targeted prevention efforts to reduce the ongoing burden of firework-related injuries in children.

Keywords:  Amputation; Burns; Fireworks; Pediatrics; Upper extremity injuries

DOI:  https://doi.org/10.1016/j.injury.2026.113498
Adv Pediatr. 2026 Aug;pii: S0065-3101(26)00004-6. [Epub ahead of print]73(1): 353-370

Climate Stewardship in the Clinical Setting.

McKenna F Parnes, Elliott M Weiss, H Mollie Grow.

  Pediatric clinicians have the potential to exert a large influence on health care sustainability for children and families as part of broader system transformation to promote sustainable practices. As a significant contributor to global greenhouse gas emissions, health care systems and providers have a responsibility to reduce emissions that negatively affect children's health. All pediatric clinicians should understand ways that we can mitigate health care impacts on our environment and should actively contribute to solutions in everyday practice through conversations with patients, trainees, and colleagues; and advocacy for institution-level, system-level, community-level, and global-level change.

Keywords:  Climate change; Climate stewardship; Environmental health; Health care sustainability

DOI:  https://doi.org/10.1016/j.yapd.2026.02.003
Hosp Pediatr. 2026 Jul 23. pii: e2026009275. [Epub ahead of print]

Characteristics of US Nonchildren's Hospitals That Lost Pediatric Inpatient Capability, 2013-2021.

Ashley A Foster, Hilary A Hewes, Rachel Crady, Morgan Leighton, Katherine E Remick.

OBJECTIVE: Most US children receive care at nonchildren's hospitals. Trends over the past 2 decades have revealed decreasing pediatric inpatient capabilities. This study aimed to describe the hospital characteristics associated with loss of pediatric inpatient capabilities among a national sample of US nonchildren's hospitals between 2013 and 2021.
METHODS: A secondary analysis was conducted using National Pediatric Readiness Project Assessments from 2013 to 2021. Hospitals with 1 or more reported pediatric inpatient unit capability (pediatric ward, pediatric intensive care unit [PICU], nursery/neonatal intensive care unit [NICU]) in 2013 and assessment responses in 2013 and 2021 were included. Multivariable logistic regression models were used to assess associations between hospital characteristics and loss of pediatric inpatient capabilities.
RESULTS: Of the 1570 included hospitals, 33.4% were urban high volume, 42.8% were nontrauma designated, and 40.9% had loss of 1 or more pediatric inpatient capability between 2013 and 2021. Multivariable analysis showed nonmetro status was associated with increased adjusted odds of pediatric ward loss (adjusted OR [aOR] 3.45; 95% CI, 2.42-4.94) and nursery/NICU loss (aOR, 2.93; 95% CI, 1.76-5.00) compared with urban high-volume hospitals. Trauma-designated hospitals had decreased adjusted odds of pediatric ward loss (aOR, 0.63; 95% CI, 0.47-0.83) and nursery/NICU loss (aOR, 0.60; 95% CI, 0.40-0.88).
CONCLUSIONS: Two in 5 hospitals with pediatric inpatient capability lost 1 or more capability between 2013 and 2021. Nonmetro hospitals had higher odds of capability loss, whereas trauma-designated hospitals had lower odds, highlighting geographic and structural disparities in pediatric inpatient service sustainability. Identifying impacts of these changes is critical to ensuring equitable access.

DOI: https://doi.org/10.1542/hpeds.2026-009275
Pediatrics. 2026 Jul 24. pii: e2025075267. [Epub ahead of print]

Trends in Pediatric Hospitalizations Following Interfacility Transfer: 2009-2022.

Sriram Ramgopal, Sriamsha Dubbaka, Kenneth A Michelson.

BACKGROUND: Pediatric care is becoming increasingly regionalized. A rise in pediatric admissions following transfer may indicate increasing pressure on health systems to accommodate pediatric care. We evaluated nationwide trends in children admitted following transfer.
METHODS: We performed a retrospective repeated cross-sectional study of the Kids' Inpatient Database in 2009, 2012, 2016, 2019, and 2022. Using logistic regression, we evaluated longitudinal changes of children admitted to the hospital following transfer overall. We stratified by hospital type, medical complexity, presence of trauma, and diagnosis. We evaluated changes in costs attributed to transferred-in patients.
RESULTS: Over the 13-year study period, overall admissions decreased by 61 344 per year (95% CI, -74,013 to -48,675). Admissions following transfer increased by 7714 per year (95% CI, 5339-10 090), and the likelihood of a transferred-in admission rose by 5.7% annually (95% CI, 4.7%-6.7%). The increase in transferred-in admissions was noted in all hospital types and with or without trauma. The likelihood of transferred-in admissions for children without medical complexity was greater than in children with medical complexity (6.4% per year [95% CI, 5.3%-7.6%] vs 4.2% per year [95% CI, 3.2%-5.2%]). Most diagnoses demonstrated an increase in transferred-in admissions. The share of costs for transferred-in patients increased from 17.2% in 2009 to 29.5% in 2022.
CONCLUSION: Transferred-in admissions and costs increased, with greatest relative increases in rural hospitals, non-medically complex children, and select admission diagnoses. These findings highlight a growing reliance on interfacility transfer and suggest a need to bolster local pediatric capacity and regional care coordination.

DOI: https://doi.org/10.1542/peds.2025-075267
Hosp Pediatr. 2026 Jul 20. pii: e2025009127. [Epub ahead of print]

Early Prediction of Critical Care Interventions From Pediatric Emergency Department Triage.

Trang Ha, Brandon Kappy, James M Chamberlain, Kenneth W McKinley.

BACKGROUND AND OBJECTIVES: Most pediatric emergency departments (EDs) in the United States use Emergency Severity Index (ESI) system to triage patients. Because the 5-level classification provides limited risk stratification, this study aims to improve patient prioritization by developing an operationally useful model that predicts risk of critical care interventions using only information available during ED triage.
METHODS: We conducted a retrospective study at a large urban academic pediatric ED from 2016 to 2024. We developed predictive models using 6 machine learning (ML) algorithms. Models were evaluated on Average Precision and tradeoff between sensitivity and positive predictive value (PPV). We performed a counterfactual analysis to assess potential clinical effects of risk predictions on timeliness of evaluation for critical care patients.
RESULTS: Among 886 183 ED visits, 26 721 (3.0%) received critical care interventions. The neural network had the highest Average Precision of 0.6 (95% CI 0.59-0.61). The model could identify 88% (87%-89%) of patients who received critical care interventions with PPV of 32% (31%-32%). Supplementing ESI with these risk predictions would have increased the proportion of critical care patients being timely evaluated by physicians from 23.3% to 75.0% for ESI 3 patients. Similarly, improvements would have been achieved for other ESI levels.
CONCLUSION: We developed models capable of quickly identifying ED pediatric patients at risk of requiring critical care interventions without causing alarm fatigue. Potential improvements in time-to-pediatrician for at-risk patients suggest utility of our ML-support triage framework in improving patient care and safety in pediatric ED.

DOI: https://doi.org/10.1542/hpeds.2025-009127
Hosp Pediatr. 2026 Jul 22. pii: e2025008731. [Epub ahead of print]

Respiratory-Related Hospital Admissions in Children and Young Adults With Down Syndrome.

Emily DeBoer, Kristine Wolter-Warmerdam, Rebecca Bernstein, Arwen Jackson, Jennifer Maybee, Karen Kelminson, Francis Hickey.

BACKGROUND: Children with Down syndrome (DS) have an increased risk for hospitalization and intensive care owing to respiratory illnesses; however, current research does not specify which co-occurring diagnoses increase this risk throughout childhood. We aim to decrease morbidity by focusing outpatient care on the most critical diagnoses. This study examines which co-occurring diagnoses increase the risk of hospitalization and need for intensive care owing to respiratory tract infections in a large cohort of children with DS.
METHODS: This retrospective review of children with DS (n = 2327), receiving care from a large clinic for children with DS between 2011 and 2023, evaluated clinical data and hospitalizations. Admission diagnosis, intensive care unit (ICU) support, co-occurring diagnoses, and demographics were reviewed.
RESULTS: Thirty percent (n = 703) of children with DS had a hospital admission owing to respiratory illness, with 340 (48.4%) having more than one inpatient stay and 65 (9.2%) requiring ICU care. Most common admission reasons were pneumonia, bronchiolitis, and respiratory failure/distress. Median age at first admission was 2.0 years (mean = 3.0 years; SD = 4.3). Children diagnosed with chronic lung disease had 2.15 times higher odds of having a respiratory-related hospitalization. Children with chronic lung disease, dysphagia with aspiration, deep laryngeal penetration without aspiration, obstructive sleep apnea, asthma/reactive airway disease, pulmonary hypertension, laryngomalacia, and Medicaid insurance status were more likely to require multiple hospital admissions.
DISCUSSION: Children with DS have a high rate of hospital admissions related to respiratory tract infections. Co-occurring pulmonary diagnoses increase the risk of recurrent hospitalizations.

DOI: https://doi.org/10.1542/hpeds.2025-008731
Nursing. 2026 Aug 01. 56(8): 20-25

Childhood exposure to pornography and the normalization of online exploitation.

Heidi Olson.

   ABSTRACT: As technology is rapidly changing, so are the ways that children are being groomed, abused, and exploited online. Children are being exposed to online pornography in unprecedented numbers, leading to multiple mental health, physical, and social consequences. Early exposure to pornography normalizes sexual violence and objectification and desensitizes children to sexually explicit content. While children are being desensitized to pornography, many children are also being asked to exploit themselves by sending sexually explicit photos and videos of themselves via social media, apps, and video games. The crime of exploitation escalates further when offenders offer items of monetary or nonmonetary value in exchange for sexually explicit photos and/or videos. This exchange meets the criteria of commercial sexual exploitation of children. Due to the normalization of sexually explicit content, children may not realize that they are being exploited in these situations. Clinicians need to understand the signs of exploitation because many pediatric victims encounter health care professionals during or after their abuse. It is also imperative for health care workers to understand how to ask trauma-informed screening questions and how to help patients and their families navigate next steps and resources when a child is being harmed and exploited online. This article discusses childhood exposure to pornography and how it normalizes self-exploitation, as well as the pivotal role that nurses play in providing education on these issues, screening for online harm, and providing trauma-informed resources.

Keywords:  CSEC; OnlyFans; online exploitation; pediatrics; pornography; screening; sex trafficking; trauma-informed

DOI:  https://doi.org/10.1097/NSG.0000000000000432
Arthrosc Sports Med Rehabil. 2026 Jul 09. e70048

Basketball-Related Injuries Increased in Pediatric Patients Presenting to United States Emergency Departments Between 2019 and 2023 With Strains and Sprains Being the Most Common Injury Types.

Samisha M Khangaonkar, Marshall S Yuan, Calvin J Wang, Ryan Cheng, Billy I Kim, Joseph Manzi, Jay Moran, Andrew E Jimenez.

Purpose: To estimate the number, risk factors, and types of basketball-related injuries in pediatric patients who presented to United States emergency departments between 2019 and 2023, as estimated by the National Electronic Injury Surveillance System (NEISS).
Methods: Pediatric patients (<18 years old) with basketball-related injuries who presented to NEISS-affiliated emergency departments between 2019 and 2023 were identified. Narratives were retrospectively reviewed and data were categorized by injury type and location. National weighted estimates provided by the NEISS based on geographical location were then used to stratify injuries by patient demographics, discharge disposition, and hospital size. Univariate analyses were conducted to compare hospital admission rates by age group, sex, and injury-related variables.
Results: From 2020 to 2023, the number of estimated basketball-related pediatric injuries increased 89% for children (ages 7-11, 19,869 vs. 37,616 estimated injuries) and 64% for adolescents (ages 12-17, 95,504 vs. 156,599 estimated injuries). Strains, sprains, and fractures represented over half (53%) of all injuries (92,548 estimated injuries). Multivariable analyses showed that children were at a decreased risk for hospitalization (OR: .80, 95% CI: .63-.99, P = .044) compared with adolescents, whereas men were at an increased risk of hospitalization (OR: 2.01, 95% CI: 1.54-2.67, P < .001) compared with women. Patients who presented to small hospitals (OR: .28, 95% CI: .17-.43, P < .001) and medium hospitals (OR: .16, 95% CI: .07-.32, P < .001) were significantly less likely to be admitted compared with those who presented to large, very large, and children's hospitals.
Conclusions: The number of estimated basketball-related injuries for children and adolescents substantially increased between 2020 and 2023, where strains and sprains represented the most common injury types. Risk factors for hospital admission included older age at the time of presentation, male sex, fractures, dislocations, and larger hospital size.
Level of Evidence: Level IV, retrospective case series.

DOI: https://doi.org/10.1002/ars2.70048
Pediatrics. 2026 Jul 23. pii: e2026075971. [Epub ahead of print]

Influenza, COVID-19, and RSV Vaccinations for Immunocompromised Children and Household Contacts.

Carol M Kao, Hannah Bahakel, Taylor A Heald-Sargent, Timothy D Minniear, Victoria A Statler, Sanya J Thomas, Kathryn E Weakley, Qing Cao, Monica I Ardura, Lara Danziger-Isakov, Marc Foca, Betsy C Herold.

Immunocompromised pediatric patients, including hematopoietic cell and solid organ transplant recipients, those undergoing chemotherapy for malignancy, and those receiving biologic response modifiers for autoimmune or inflammatory conditions, are at risk for severe disease from vaccine-preventable respiratory viral infections such as influenza, SARS-CoV-2 (COVID-19), and respiratory syncytial virus (RSV). These children face higher rates of hospitalization, intensive care admissions, and mortality, reflecting contributions from an immature immune system, absence of immunologic memory, and/or increased environmental exposures. Immunization recommendations for immunocompromised children are largely extrapolated from studies conducted among healthy children and/or immunocompromised adults due to a paucity of primary data on immunological responses and vaccine efficacy in immunocompromised children. Trends in vaccine hesitancy in the general population, ongoing transmission of respiratory viral infections in the community, and suboptimal vaccination rates among immunocompromised children and their household contacts further compound the risk for this vulnerable population. As the number of children with immunocompromising conditions expands, it is imperative that primary care practitioners and subspecialists who care for immunocompromised children ensure appropriate immunizations are provided to these patients and their household and community contacts. We will review available data supporting the current guidelines regarding vaccine dosing, scheduling, and formulations to prevent influenza, COVID-19, and RSV infections in immunocompromised children. Furthermore, we highlight key knowledge gaps and areas of current investigation aimed at improving respiratory viral vaccine immunogenicity and optimize protection.

DOI: https://doi.org/10.1542/peds.2026-075971
Radiographics. 2026 Aug;46(8): e250060

Rapid MRI for Pediatric Acute Abdominopelvic Pain in the Emergency Department: Review of Imaging Technique, Implementation, and Diagnoses.

Katherine N Epstein, Tracee Wee, Justine Kemp, Cara E Morin, Gary R Schooler, Rama S Ayyala.

Rapid MRI is a short and noninvasive examination with limited sequences that enables the prompt and accurate diagnosis of emergent and urgent causes of acute abdominal pain in the pediatric emergency department. Its advantages include rapid imaging of the entire abdomen and pelvis without the need for breath holds or intravenous contrast agents. This single examination can replace multiple US examinations (such as limited abdomen US for the appendix and pelvic US for ovarian torsion) without the delay potentially needed to fill the urinary bladder for a transabdominal pelvic US examination. A stepwise approach to implement a rapid MRI program is presented, and the authors emphasize stakeholder engagement, protocol development, billing code determination, educational dissemination to various stakeholder groups, and successful program implementation and maintenance. The authors describe essential core sequences, which include axial and coronal T2-weighted single-shot sequences with and without fat saturation, along with pertinent case examples to review relevant pathologic conditions and their appearance with the rapid MRI sequences. Familiarity with key MRI findings and clinical features of common and uncommon causes that are encountered in pediatric emergency settings, such as acute appendicitis and ovarian torsion, is crucial for accurate diagnosis and appropriate management and treatment. Important tips and potential pitfalls are highlighted to avoid misdiagnoses and ensure that radiologists have the tools to maintain high standards of care in pediatric imaging. ©RSNA, 2026.

DOI: https://doi.org/10.1148/rg.250060
Pediatrics. 2026 Jul 21. pii: e2026076194. [Epub ahead of print]

Building the Foundations for Trustworthy AI in Pediatrics.

Samuel G Finlayson, Aaron Wightman, Elliott Mark Weiss, Vittorio Gallo, Naveed Rabbani, Douglas S Diekema, Chethan Sarabu, Holly Hòa Võ, Katherine E MacDuffie, Mjaye Leslie Mazwi, Yu-Hsiang Clara Lin, Douglas J Opel.

Artificial intelligence (AI) adoption in health care is rapidly accelerating, with pediatrics positioned to benefit from improvements in quality, efficiency, and access to care. Recent frameworks have articulated ethical commitments for trustworthy AI in pediatrics, but less attention has been paid to the foundational infrastructure required to achieve them. In this article, we examine the challenges that emerge at the intersection of AI and pediatrics: unique challenges that AI poses for pediatric care, including nonintuitive errors, impacts on clinician cognition, and new infrastructure requirements; and unique challenges that pediatrics poses for AI, including adequate training data, accommodation of developmental heterogeneity, and navigation of evolving patient autonomy. We then outline the data systems, governance structures, validation frameworks, and public trust infrastructure that must be established before the field can meet these challenges. We conclude with concrete recommendations for clinicians, caregivers, health care systems, government, technologists, and academic institutions seeking to lay the foundation for trustworthy and beneficial AI in pediatrics.

DOI: https://doi.org/10.1542/peds.2026-076194
J Pediatr Soc North Am. 2026 Aug;16 100406

Integrating Psychological Care into Pediatric Sports Medicine: Levels of Collaboration and Common Referral Concerns.

Chelsey Bowman, Sabrina Gretkierewicz, Jacqueline M Pabis, Abigail Bushnell, Rachel Sweenie, Casey Lawless, Jamie Shoop, Morgan Daffin, Emily J Stapleton, Kirby Knapp, Catherine Butz.

  It is well established that psychological factors impact sport injuries, recovery, and return to sport among youth athletes. Medical associations and sport governing bodies have advocated for the assessment and intervention of mental health concerns among athletes. However, there is less research on methods of incorporating pediatric psychology services within sports medicine (SM) settings. By drawing on the framework of the Substance Abuse and Mental Health Services Administration-Health Resources and Services Administration for understanding and implementing medical and behavioral health integration, this paper outlines various approaches to utilizing pediatric psychologists' expertise in the treatment of youth athletes. Specifically, the paper focuses on how pediatric psychologists can support patient needs, contribute to research goals, and expand reach in SM clinics through coordinated, colocated, and integrated levels of care.
Key Concepts: (1)Despite calls to assess and address athletes' mental health, there is little guidance on how to integrate psychology into pediatric sports medicine (SM) clinics.(2)Applying and adapting a preexisting framework for behavioral health and medical specialty integration provides guidance on how to integrate psychology into pediatric SM clinics.(3)Thoughtful relationships and integration between psychology and pediatric SM clinics have the potential to expand access, reduce stigma, and further the reach of SM clinics.

Keywords:  Mental health; Psychology; Sports medicine

DOI:  https://doi.org/10.1016/j.jposna.2026.100406
J Community Health. 2026 Jul 23.

Social Identities and Vaccine Exemptions in the United States: The Role of Religiosity, Partisanship, and Vaccine Hesitancy.

Matthew R Boyce, Christine Crudo Blackburn, Syeda Sharmin Duza.

  Nonmedical vaccine exemptions are increasingly common in the United States and threaten population immunity levels in children. While vaccine hesitancy and pediatric vaccination coverage in the United States have been extensively researched, work focused on vaccine exemptions remains relatively limited. The objectives of this study are to examine associations between parental religious, partisan, and vaccine-hesitant social identities and vaccine exemptions. A national, cross-sectional survey was conducted from August 20 through September 9, 2025. Parents and legal guardians of children five years of age or younger were recruited from an online panel and asked if their child had ever missed a vaccination due to a medical or nonmedical vaccine exemption. A total of 1,042 respondents were included in the data analysis, 72 of whom reported that their child did not receive a vaccine due to a nonmedical exemption. The prevalence of nonmedical vaccine exemptions differed significantly according to respondent race, partisanship, religiosity, and vaccine-hesitant identity. Multiple logistic regression modeling produced significant associations between nonmedical exemptions and race, education, religiosity, and vaccine-hesitant identity. These findings reinforce previously identified predictors of vaccine hesitancy in the United States but also extend the evidence base by explicitly examining predictors of vaccine exemptions.

Keywords:  Adolescent health; Child health; Immunization; Public health; Vaccine mandate; Vaccine policy

DOI:  https://doi.org/10.1007/s10900-026-01597-4
J Hosp Palliat Nurs. 2026 Jul 21.

Legacy at the Bedside: A Nurse-Led Evidence-Based Framework for Memory-Making in the Pediatric Intensive Care Unit.

Klarysa Torrez, Kristina Ursua, Hillery Phillips, Weerapong Lilitwat.

  Children who die in the pediatric intensive care unit (PICU) and their families often face sudden deterioration, limited time, invasive technology, and emotionally overwhelming decisions. Memory-making can help families preserve connection, support parenting and sibling participation, and create tangible or digital keepsakes, yet bedside teams may feel uncertain about when and how to offer these practices without adding distress. This evidence-based practice article synthesizes recent pediatric palliative care, bereavement, and critical care literature and translates it into a nurse-led bedside framework for the PICU. The proposed LEGACY-PICU framework moves from listening to what matters most, through explaining options gently, guiding participation in a choice-centered way, acknowledging culture and faith, and creating keepsakes safely, to yielding space for privacy and ritual. PICU-specific actions include preparing supplies; integrating child life, palliative care, chaplaincy, and social work; coordinating timing around withdrawal of life-sustaining therapies or organ donation; and unburdening staff through role clarity and debriefing. A structured but flexible approach may help nurses and interdisciplinary teams offer memory-making as a compassionate invitation rather than a task.

Keywords:  bereavement; end-of-life nursing; memory-making; pediatric intensive care unit; pediatric palliative care

DOI:  https://doi.org/10.1097/NJH.0000000000001259
Am J Respir Crit Care Med. 2026 Jul 24. pii: aamag375. [Epub ahead of print]

An Update to the Classification, Evaluation, and Management of Childhood Interstitial Lung Disease in Infancy: An Official American Thoracic Society Clinical Practice Guideline.

American Thoracic Society Assembly on Pediatrics

   BACKGROUND: Childhood interstitial lung diseases (chILD) are a heterogeneous group of rare disorders. In 2013, the American Thoracic Society (ATS) developed a guideline regarding the classification, evaluation, and management of children <2 years old with chILD. The current guideline provides updated recommendations regarding genetic testing, chest imaging, lung biopsy, and lung transplant referral.
METHODS: The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to form clinical questions, summarize evidence, and develop recommendations, following ATS policies and procedures. A multidisciplinary panel with expertise in chILD formulated recommendations addressing diagnostic tools and referral for lung transplant evaluation.
RESULTS: Rapid and broad genetic testing is recommended for infants with chILD and respiratory failure (strong recommendation). Chest CT remains an important part of the diagnostic evaluation (conditional recommendation). Surgical lung biopsy is recommended when there is urgency to identify a specific chILD disorder and genetic testing is not feasible, timely, or inconclusive, to identify histopathologic 'treatable traits', or to inform prognosis (strong recommendation). Referral for lung transplant evaluation is recommended for children with specific chILD disorders with predictably poor outcomes (strong recommendation). Repeat chest CT to aid decision-making, prognosis, and/or change therapies is suggested for children with chILD diagnosed before age 2 years (conditional recommendation).
CONCLUSIONS: This guideline provides evidence-based recommendations for genetic testing, chest imaging, lung biopsy, and referral for lung transplant evaluation to improve the diagnostic evaluation and management of children <2 years with chILD. Implementing this guideline will hopefully increase genetic testing for chILD, inform the diagnostic evaluation and disease monitoring of chILD, and identify future research priorities for chILD.

Keywords:  chILD syndrome; chest computed tomography; genetic testing; lung histopathology; referral for lung transplant evaluation

DOI:  https://doi.org/10.1093/ajrccm/aamag375
J Autism Dev Disord. 2026 Jul 21.

Access to Autism Behavioral Therapy Services: An Analysis of 2022-2023 National Survey of Children's Health Data.

Alexandra Lauren Wicker, Vincent Sutherland, Ellie Paez, Veronica Underwood Carrasco, Katharine Zuckerman, Olivia Lindly.

   PURPOSE: Children with autism spectrum disorder (ASD) frequently face barriers to accessing care. While prior research has explored general disparities in healthcare utilization, few studies have specifically examined barriers to behavioral therapy, a key recommended intervention for ASD. This study aimed to identify factors associated with access to behavioral therapy for children with ASD.
METHODS: We analyzed data from the 2022-2023 National Survey of Children's Health. Our outcome was reported access to behavioral therapy among children with ASD, which we explored across child age, sex, race/ethnicity, poverty level, rurality, insurance type, parent household language, and parent education level. Descriptive statistics and chi-square tests were initially used to assess associations between these variables and therapy access. We then fit a logistic regression model to estimate independent predictors.
RESULTS: Rural residence and having a caregiver with less than a high school education were both significantly associated with lower rates of behavioral therapy use. Insurance status was also crucial: children with public insurance or both public and private coverage had over three times the odds of accessing therapy compared to uninsured children.
CONCLUSION: Disparities in behavioral therapy access persist for children with ASD, particularly in rural and lower-education households. Strategies such as expanding telehealth delivery, increasing insurance outreach, and funding family navigation services may help reduce these gaps, requiring collaboration between policymakers and providers.

Keywords:  Autism; Behavioral therapy; Health care access; Parent education; Rural health

DOI:  https://doi.org/10.1007/s10803-026-07457-3
Campbell Syst Rev. 2026 Sep;22(3): 18911803261469847

Bereavement Interventions for Children and Adolescents: An Evidence and Gap Map of Primary Studies and Systematic Reviews.

Leonor Rodriguez, James Lyons, Amy Maloy, Ailsa O'Brien.

   Background: Experiencing the death of a loved one can be very distressing for children and adolescents. If the bereavement is not managed, it can lead to lifelong consequences such as poor mental health outcomes. Despite this being a universal experience, there is a lack of agreement in the theoretical definitions of fundamental concepts of grief, loss and bereavement. Research has suggested child grief has specific characteristics determined by their age and developmental stage and needs, as well as the circumstances surrounding the death. A significant challenge in the field is identifying age appropriate and validated interventions that are specific for children and adolescents. Evidence and Gap Maps (EGMs) can contribute to addressing this gap by providing a comprehensive and visual synthesis of the existing evidence.
Objectives: This EGM aimed to identify, synthesise and map existing published and unpublished (grey literature) evidence of primary studies and systematic reviews of bereavement interventions for children and adolescents, targeted at improving psychosocial outcomes.
Search Methods: The searches for this EGM were carried out using electronic databases (n = 6), web search engines, repositories and grey literature. The search terms were developed based on the participants, bereavement terminology and types of interventions. Searches were conducted over May and June 2024.
Selection Criteria: All primary studies and systematic reviews of bereavement interventions for children and adolescents between 0 and 24 years of age, in English or Spanish were included in this EGM.
Data Collection and Analysis: Search results were imported into EndNote, where results were collated and duplicates deleted. Results were then imported into EPPI-reviewer where additional duplicates were removed. Titles and abstracts were screened in duplicate. Potential studies were then divided and full text was screened in duplicate, a third reviewer resolved any conflicts. Data was extracted from sources that fit the inclusion criteria in duplicate. The information extracted was participant age, country, study design, intervention type, intervention name, duration, form of delivery, provider, target death and type of death, evaluation and outcomes.
Results: A total of 99 sources are included in this EGM. Interventions were carried out in different parts of the world but most evidence was identified in the USA, Australia, Canada and The Netherlands. The age that most evidence concentrated on is the age group between 10 to 14 years with underpinning theories, cognitive behavioural therapy and expressive therapies the most reported. The majority of interventions were delivered face to face and included different types (interventions, programmes, support groups and camps). Most reported a duration of 6-10 sessions and targeted parental death. Outcomes reported were various (n = 49), mostly focused on grief, coping, emotional expression, adjustment to death and emotional wellbeing. The majority of systematic reviews were rated as low quality and the majority of domains classified for randomised control trials were unclear.
Conclusions: This EGM provides a systematic, searchable and visual tool for policy makers, practitioners, researchers and members of the public to identify the existing evidence on bereavement interventions for children and adolescents. The EGM identified the areas where most evidence is currently concentrated, as well as areas where further research is warranted for specific age groups and types of death experienced. The EGM also identified the need for higher quality evidence as well as longitudinal evaluations.

Keywords:  bereavement grief death children adolescents

DOI:  https://doi.org/10.1177/18911803261469847
Cochrane Database Syst Rev. 2026 Jul 23. 7 CD015898

Larger versus smaller red blood cell volume per transfusion in hospitalized adults, children and preterm neonates.

Nadia Roumeliotis, George Sabbagh, Meriem Belkacem, Philippe Dodin, Genevieve Du Pont-Thibodeau, Jeannie Callum, Marisa Tucci, François Martin Carrier, Jacques Lacroix.

RATIONALE: While substantial research has evaluated the safety of hemoglobin thresholds and storage length for red blood cell (RBC) transfusion, there is minimal literature on RBC transfusion volume per transfusion event in hospitalized patients. The Choosing Wisely initiative has made a recommendation to transfuse a single unit of RBC per transfusion event, although this is based on little evidence. No recommendation has been made for pediatrics. This review evaluates the effect of the volume of RBC transfusion, administered when the decision has been made to transfuse a hospitalized patient, on mortality and other important outcomes.
OBJECTIVES: To compare the effectiveness and safety of larger versus smaller RBC volume per transfusion for anemia in hospitalized adults, children, and preterm neonates.
SEARCH METHODS: We searched Evidence-Based Medicine Reviews (EBMR; including CENTRAL), MEDLINE, Embase, Web of Science, and other databases on 5 August 2025, with reference checking, citation searching and contacting study authors to identify additional studies.
ELIGIBILITY CRITERIA: Eligible studies were randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) that included adults, children or neonates and compared a larger volume of RBC per transfusion event (intervention) to a smaller volume of RBC transfusion (control). We defined a transfusion event as a single administration of blood products within six hours.
OUTCOMES: The critical outcome was mortality. Important outcomes were length of hospital stay, hospital-free days, transfusion-associated adverse events (TAAE), organ dysfunction, number of RBCs transfused, rebleeding and allogeneic donor exposure.
RISK OF BIAS: We assessed risk of bias using the Cochrane RoB 2 tool for RCTs and the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) version 2 tool for NRSIs.
SYNTHESIS METHODS: Two authors independently extracted data from included studies and assessed the risks of bias. We analyzed data from the included RCTs and NRSIs separately. We used the risk ratio (RR) and mean difference (MD) for pooled effects, using a random-effects model to account for heterogeneity between studies. We used GRADE to assess the certainty of evidence.
INCLUDED STUDIES: We included 12 studies (5478 participants); five RCTs, and seven controlled NRSIs. Nine studies included adults (1945 participants), one included children (3199 participants) and two included preterm neonates (334 participants). Eight of the adult studies' participants were in hematology wards or bone marrow transplant units, and one study included postpartum participants. The pediatric study included anemic children, and the neonatal studies included preterm infants < 32 weeks' gestation or weighing < 1.5 kg. All adult studies compared two units of RBCs to one unit of RBCs per transfusion event. The pediatric study compared 15 mL/kg to 10 mL/kg RBCs, and the neonatal studies compared 20 mL/kg to 10 mL/kg RBCs. The included RCTs ranged from low to high risk of bias and the NRSIs ranged from low to critical risk of bias.
SYNTHESIS OF RESULTS: Nine studies reported on mortality, although the definition of time of death varied. Meta-analysis of adult studies demonstrated no difference in mortality between the two-unit RBC transfusion group and the one-unit RBC transfusion group in RCTs (RR 1.29, 95% CI 0.62 to 2.67; 2 RCTs, 322 participants; low-certainty evidence) or in NRSIs (RR 1.03, 95% CI 0.62 to 1.71; 5 NRSIs, 1198 participants; low-certainty evidence). There was no difference in hospital length of stay between the two-unit RBC group and the one-unit RBC group in RCTs (MD 0.08, 95% CI -0.66 to 0.82; 2 RCTs, 311 participants; low-certainty evidence) and in NRSIs (MD -0.15, 95% CI -1.68 to 1.38; 4 NRSIs, 1048 participants; very low-certainty evidence). No studies reported hospital-free days as an outcome. There was no difference in TAAEs between the two-unit RBC group and the one-unit RBC group for RCTs (RR 1.25, 95% CI 0.61 to 2.56; 3 RCTs, 388 participants; low-certainty evidence) or NRSIs (RR 0.74, 95% CI 0.30 to 1.82; 3 NRSIs, 546 participants; very low-certainty evidence). During their hospital stay, participants in the two-unit RBC transfusion group received more RBC units than those in the one-unit RBC transfusion group in the NRSIs (MD 0.65 units, 95% CI 0.55 to 0.75; 4 NRSIs, 1064 participants; low-certainty evidence). However, no difference was seen between groups in the RCTs (MD 0.90 units, 95% CI 0.68 to 1.11; 3 RCTs, 378 participants; low-certainty evidence). During each transfusion event, patients in the two-unit RBC transfusion group received 0.66 RBC units more compared to those in the one-unit RBC group (MD 0.66 units, 95% CI 0.59 to 0.73; 3 NRSIs, 791 participants), reflecting adherence to the intervention. There was no difference between the two RBC transfusion groups' rates of thrombosis reported in RCTs (RR 2.26, 95% CI 0.51 to 9.95; 2 RCTs, 311 participants; very low-certainty evidence). No NRSIs reported rates of thrombosis. There was no difference between the two RBC transfusion groups' rebleeding rates in either RCTs (RR 0.52, 95% CI 0.16 to 1.68; 1 RCT, 245 participants; moderate-certainty evidence) or NRSIs (RR 0.64, 95% CI 0.36 to 1.14; 3 studies, 585 participants; very low-certainty evidence). No studies reported on allogenic donor exposure.
AUTHORS' CONCLUSIONS: In adults, when comparing two units of RBCs (larger volume) to one unit of RBCs (smaller volume) for a single transfusion event, there was no difference in mortality, length of hospital stay or TAAEs, albeit with low or very low-certainty evidence. However, it reduced the number of required RBC units. The results indicate that a larger transfusion volume confers no clinical benefit over a smaller, more restrictive transfusion strategy (lower transfusion volume), but may lead to a higher amount of blood administered. Given the adverse events associated with RBC transfusion and the resource limitation of the allogeneic blood supply, it is reasonable to support the recommendations for single unit RBC transfusion per transfusion event in adults. In children, evidence is still too limited to be able to make a recommendation on an RBC volume.
FUNDING: This study did not receive funding.
REGISTRATION: This review protocol was previously published with the Cochrane database of systematic reviews (DOI 10.1002/14651858.CD015898).

DOI: https://doi.org/10.1002/14651858.CD015898.pub2
Child Neuropsychol. 2026 Jul 22. 1-21

The use of mindfulness based interventions for school-aged children with ADHD in the United States - a literature review.

Monica Y Garza Saenz, Ila A Iverson, Beatriz MacDonald, Sari Bar, Ellen Greenwald, Ana El-Behadli, Veronica Bordes Edgar.

  Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most commonly diagnosed chronic childhood disorders in the United States (U.S.). Children with ADHD struggle to function across multiple settings and undermanaged symptoms can impact academic performance, home life, and social conduct. Mindfulness-Based Interventions (MBIs) have been increasingly proposed as a non-pharmacological treatment for ADHD among children globally. However, the application and adaptation of MBIs for the management of ADHD in children in the U.S. is in the early stages of development and study. The purpose of this literature review was to examine the description, presentation, and implementation of MBIs employed in the U.S. to manage ADHD symptoms in school-aged children. A total of six studies were identified and included. Several studies included in this review suggest that there is preliminary support for the use of MBIs to reduce hyperactive and inattentive symptoms among children with ADHD in the U.S. However, limitations such as small, unrepresentative samples sizes and a lack of inclusion control groups in several reviewed studies indicate that while MBIs may be effective as adjunctive treatment for ADHD, they are not yet a generalizable, evidence-based treatment method for children with ADHD. Larger scale, longitudinal studies, particularly among diverse populations and in rural locations, could serve to bolster the evidence base for MBIs among children with ADHD in the U.S.

Keywords:  ADHD; United States; children; mindfulness

DOI:  https://doi.org/10.1080/09297049.2026.2706034
Arthrosc Sports Med Rehabil. 2026 May 22. e70034

Lower Extremity Sprains and Knee/Ankle Injury Predominate Among Pediatric Dancers.

Katherine Koch, Philip M Lee, Cameron Nishida, Sonya B Levine, Kyle K Obana, Jennifer M Weiss, Jennifer King.

Purpose: To determine the most common body regions, diagnoses, and mechanisms of injury among pediatric dance-related injuries in the United States.
Methods: A descriptive epidemiologic analysis of the National Electronic Injury Surveillance System from January 1, 2019 to December 31, 2023 identified emergency department presentations for primary dance-associated injuries using the recreational activity code 3728. Data on demographics, body region, diagnosis, and mechanism of injury were collected. Patients were stratified by sex (male vs female) and age (children (3-9) vs adolescents (10-17)). Descriptive statistics and chi-square tests were used, with significance set a P < .05.
Results: A total of 3600 (National Estimate = 93,062) cases were analyzed. The most commonly injured regions were knees (20.8%) and ankles (15.8%). The most common diagnoses were sprains/strains (31.4%) and fractures (12.3%). Common mechanisms included impacts with the floor (37.0%) and ankle rolling (13.5%). Compared with adolescent dancers, children sustained knee (26.2% vs 5.5%, P < .001) and ankle (17.5% vs 10.4%, P < .001) injuries, experience sprains/strains (35.5% vs 18.3%, P < .001), and were injured due to ankle rolling (14.4% vs 8.1%, P < .001) and noncontact movements (11.8% vs 2.3%, P < .001). Adolescent dancers more often sustained fractures (14.4% vs 11.3%, P = .010). Females were more likely to sustain knee (21.8% vs 15.3%, P < .001) and ankle (16.6% vs 11.7%, P = .012) injuries and experience sprains/strains (33.1% vs 22.2%, P < .001), whereas males frequently sustained head injuries (23.7% vs 11.5%, P < .001) and fractures (15.7% vs 11.7%, P = .019).
Conclusions: Knees and ankles were the most commonly injured body regions, with sprains/strains and fractures representing the most frequent diagnoses. The most common mechanisms of injury included impact with the floor, ankle rolling, and noncontact movements. Females and younger children were significantly more likely to sustain knee and ankle injuries and experience sprains/strains, whereas males and adolescents more often sustained fractures.
Level of Evidence: Level IV, retrospective epidemiological study.

DOI: https://doi.org/10.1002/ars2.70034
NCHS Data Brief. 2026 Jul;

Leading Mechanisms of Unintentional Injury Death Among Youth Ages 10-19 Years: United States, 2024.

Anne M Zehner, Matthew F Garnett.

Introduction: Unintentional injuries are the leading cause of death for youth ages 10-19 years in the United States. This report describes differences in unintentional injury death rates among youth ages 10-19 in 2024 by age group, sex, race and Hispanic origin, and census region.
Methods: National Vital Statistics System underlying cause-of-death mortality data were used to describe unintentional injury death rates among youth ages 10-19 by sex, race and Hispanic origin, and census region. Unintentional injury deaths were identified using International Classification of Diseases, 10th Revision underlying cause-of-death codes V01-X59 and Y85-Y86, with leading mechanisms of motor vehicle traffic, poisoning, and drowning identified within this subset. Death rates per 100,000 population were calculated. Pairwise rate comparisons were performed using z tests or by comparing 95% confidence intervals calculated with the gamma method when rates were based on fewer than 100 deaths.
Key Findings: The unintentional injury death rate among youth ages 10-19 years in 2024 was 11.6 deaths per 100,000 population. The motor vehicle traffic death rate for youth ages 15-19 years (12.0) was 6 times the rate among youth ages 10-14 years (2.0). The unintentional injury death rate among male youth (16.3) was higher than among female youth (6.7), with similar differences observed in motor vehicle traffic, poisoning, and drowning death rates. American Indian and Alaska Native, non-Hispanic youth had the highest rates of unintentional injury, motor vehicle traffic, and poisoning death compared with other race and Hispanic-origin groups. Death rates among youth were highest in the South for all unintentional injuries (13.8).

DOI: https://doi.org/10.15620/cdc/252457
Pediatr Blood Cancer. 2026 Jul 25. e70530

A Qualitative Analysis of Parent-AYA Communication About Cancer Predisposition Diagnosed During Pediatric Cancer Care.

Katianne M Howard Sharp, Alise Blake, Carolyn Humphrey, Jessica S Flynn, Lynn Harrison, Rose B McGee, Belinda N Mandrell, Kim E Nichols.

   BACKGROUND: Cancer-predisposing germline variants are increasingly identified and disclosed during pediatric oncology clinical care. To understand whether and how parents communicate about identified cancer predisposition syndromes (CPS) with their adolescent and young adult (AYA) children, this study qualitatively characterized the content and approach (e.g., timing) of parent-AYA communication about AYAs' CPS.
PROCEDURE: AYAs with a CPS identified during clinical cancer care and their parents independently completed semi-structured interviews regarding their CPS-related communication. Interviews were completed 1.0-3.99 years following genetic test result disclosure and coded using inductive content analysis.
RESULTS: Twenty-one AYAs (age 13-20 years) and 24 parents (17 mothers, 6 fathers, 1 grandmother) completed interviews. Although most parents reported repeatedly communicating with their child, several AYAs did not recall these conversations and nearly half described a one-time conversation. Parents described communicating to disclose genetic results, educate regarding cancer risk, attend to AYAs' emotions, and provide anticipatory guidance for future risk management. Parents whose AYA had a CPS conferring risk for adult-onset cancers (e.g., colon cancer) expected to continue to remind their AYA about cancer surveillance well into adulthood. Parents and AYAs described their CPS-related communication as "light," prompted by the AYAs' medical appointments and questions, and impacted by parents' understanding of the CPS.
CONCLUSIONS: Our findings highlight areas for targeted genetic education and support. Parents may benefit from screening to ascertain their CPS understanding, education regarding AYAs' CPS-related information and emotional support needs, and support for transitioning AYAs to independently manage CPS-related health needs.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04848142.

Keywords:  cancer predisposition; communication; hereditary cancer; pediatric cancer

DOI:  https://doi.org/10.1002/1545-5017.70530
J Pain Symptom Manage. 2026 Jul 24. pii: S0885-3924(26)00903-6. [Epub ahead of print]

Subcutaneous Drug Administration in Pediatric Palliative Home Care: A Multicenter Prospective Study.

Belén Riva de la Hoz, Marta Echávarri de Miguel, Cristina Latre Gorbe, Ángela Tristancho-Pérez, Beatriz García-Palop, Beatriz Garrido Corro, Elisabet Nogué-Pujadas, Maite Bosch-Peligero, Regina Juanbeltz Zurbano, Lucía Yunquera-Romero, Isabel García-López.

   CONTEXT: Pediatric palliative care patients frequently present with complex, life-limiting conditions and a high symptom burden requiring effective therapeutic strategies. The subcutaneous route is an important alternative for symptom control care when enteral or intravenous administration is not feasible. However, evidence supporting its use in children remains limited.
OBJECTIVE: To describe real-world use, safety, and administration characteristics of subcutaneous drug administration for symptom control in children receiving palliative home care.
METHODS: A multicenter, prospective observational study was conducted between April 2023 and June 2024 across Pediatric palliative care Units from nine Spanish hospitals. Pediatric patients receiving home-based palliative care and requiring subcutaneous drug administration were included. Data were collected at patient, catheter, and treatment levels. Descriptive statistics and mixed-effects logistic regression models were used to evaluate factors associated with catheter-related complications.
RESULTS: Forty patients, 140 subcutaneous catheters, and 214 treatment episodes were analyzed. The main indication for subcutaneous use was inadequate symptom control with other routes (75%). Median catheter dwell time was 6 days (IQR, 2.7-12.2). Catheter-related complications occurred in 40% and were predominantly mild local reactions, mainly induration. Most treatments consisted of single-drug regimens administered by continuous infusion. Midazolam (58.9%) and morphine (33.6%) were the most commonly administered drugs. Scopolamine was associated with increased complication risk (OR, 6.94; 95% CI, 1.14-42.18; P=.035).
CONCLUSIONS: Subcutaneous drug administration was a feasible and generally safe strategy for symptom control in pediatric palliative home care. These findings support collaborative research to standardize pediatric subcutaneous therapy.

Keywords:  Pediatrics; drug administration; home care services; palliative care; subcutaneous infusions; symptom management

DOI:  https://doi.org/10.1016/j.jpainsymman.2026.07.018
Subst Use Addctn J. 2026 Jul 19. 29767342261464001

Implementing Screening, Brief Intervention, and Referral to Treatment in the Emergency Department: A Qualitative Evaluation of Impact and Challenges.

David L Perlmutter, Fatima H Al-Shimari, Jennifer G Wyatt.

   BACKGROUND: Emergency departments (EDs) serve as a critical point of care for individuals with unmet substance use disorder (SUD) treatment needs. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based approach designed to proactively identify and mitigate substance use risk. We sought the perspectives of individuals responsible for delivering ED-based SBIRT to better understand the impact on patients and ED processes and identify challenges in implementing SBIRT.
METHODS: In-depth interviews were conducted with clinicians and supervisors (n = 9) involved in SBIRT delivery at 2 emergency departments in King County, Washington, United States. Thematic analysis was used.
RESULTS: ED-based SBIRT has benefits to patients as well as other providers. SBIRT leverages teachable moments following substance-related injuries and emphasizes patient autonomy to provide a form of substance use care that would not otherwise be available in the ED. There are ancillary benefits to the ED, including improved interprofessional collaboration, increased capacity for substance use care, and perceived destigmatization among other healthcare providers. Persistent resource constraints-including limited reimbursement for core components of SBIRT and lack of access to many treatment options-were identified as challenges to implementation.
CONCLUSIONS: Reliable referral networks, integration of immediate treatment access, and sustained investment in staff training are critical to maximizing the benefits of SBIRT programs. While gaps in the behavioral health continuum continue to present challenges, SBIRT remains a vital intervention for connecting patients to care and shaping ED practices toward improved SUD outcomes. These findings are relevant for individuals responsible for implementing similar programs as well as implementation-focused researchers.

Keywords:  brief intervention; emergency department; motivational interviewing; referral; screening; substance use

DOI:  https://doi.org/10.1177/29767342261464001